Common use of REQUIREMENT   TO   NOTIFY   THE   INSURER Clause in Contracts

REQUIREMENT   TO   NOTIFY   THE   INSURER. The Insured must contact Bupa Insurance Company's Claims Administrator, USA Medical Services, at least seventy-two (72) hours in advance of receiving any medical care. Emergency treatment must be notified within forty-eight (48) hours of commencement of such treatment. If the Insured fails to contact USA Medical Services as stated herein, the Insured will be responsible for thirty percent (30%) of all covered medical and hospital charges related to the claim, in addition to the plan's deductible and coinsurance (if applicable). USA Medical Services can be contacted 24 hours a day, 365 days a year at the following telephone numbers: In the U.S.A.: (000) 000-0000 Free of charge from the U.S.A.: 0-000-000-0000 Fax: (000) 000-0000 Visit My Bupa in our display options: xxx.xxxxxxxxx.xxx/XxXxxx Outside the USA: Phone number can be located on your ID card, or at xxx.xxxxxxxxx.xxx YOUR HEALTHCARE PARTNER ONLINE TO MAKE YOUR LIFE EASIER! Log in to xxx.xxxxxxxxx.xxx, search for "My Bupa" in our display options and follow the registration steps with your email to manage your policy from the comfort of your home or office. Enjoy our online services: • Access to your policy documents and ID cards • Payments • Changes request • Claim request and update information • Pre-authorization services request • Costumer Service • Virtual Care (Telemedicine) You are responsible for checking all documents and correspondence online. BUPA GROUP BENEFITS • See applicable sections of the policy for details, limitations, and restrictions. • The plan Bupa Group policy provides coverage in the Preferred Provider Network only. No benefits are payable for service rendered outside the Preferred Provider Network, except under the emergency medical treatment provision. • Maximum coverage is five million dollars ($5,000,000) per insured, per lifetime for all covered medical and hospital charges while the policy is in force, subject to the limitations herein. • The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured, per Policy Year) Maximum benefit Private or semi-private hospital room and board No limit Intensive care room and board No limit Maternity care benefit (Except Plans IV, V and VI) (No deductible or coinsurance applies) $2,500 Newborn coverage (No deductible or coinsurance applies) $25,000 Congenital and hereditary disorders: • Manifested before age 18 • Manifested on or after age 18 (per Insured, per lifetime) $100,000 $5,000,000 Organ transplant (per Insured, per lifetime) $250,000 Air ambulance transportation (per Insured, per lifetime) $25,000 Ground ambulance transportation (per incident) $1,000 Repatriation of mortal remains $5,000 Emergency treatment outside the Preferred Provider Network (per incident) $25,000 Disclosed pre-existing conditions (Lifetime maximum, per Insured after twenty-four (24) months of continuous coverage) $25,000 DEDUCTIBLE • All insureds under the Certificate have a deductible responsibility per policy year according to the plan selected by the Certificate Holder. When applicable, the corresponding deductible amount is applied per insured, per policy year before benefits are paid or reimbursed the insured submits claims or requests for reimbursement for eligible expenses that occurred during the first nine (9) months of the policy year, the benefit will be reversed, and the insured will be responsible for the following policy year's deductible. to the insured. All deductible amounts COINSURANCE paid accumulate towards the corre- • The Insured is responsible for twenty sponding maximum deductible per Certificate, which is equivalent to the sum of two individual deductibles. All insureds under the Certificate contribute to meeting the maximum percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans IV, V and VI). deductible amount of the policy. Once • One (1) coinsurance per Insured, per the maximum deductible amount policy year. of the Certificate is met, the insurer • In the event of an accident involving will consider all individual deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for multiple members of an Insured family on the same certificate, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. the following policy year, as long as • If USA Medical Services is notified there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subsequently in accordance to the policy require- ments, then coinsurance will not apply to medical services in the country of residence (except Mexico). BUPA GROUP

REQUIREMENT   TO   NOTIFY   THE   INSURER. The Insured must contact Bupa Insurance Company's ’s Claims Administrator, USA Medical Services, at least seventy-two (72) hours in advance of receiving any medical care. Emergency treatment must be notified within forty-eight (48) hours of commencement of such treatment. If the Insured fails to contact USA Medical Services as stated herein, the Insured will be responsible for thirty percent (30%) of all covered medical and hospital charges related to the claim, in addition to the plan's ’s deductible and coinsurance (if applicable). USA Medical Services can be contacted 24 hours a day, 365 days a year at the following telephone numbers: In the U.S.A.: (000) 000-0000 Free of charge from the U.S.A.: 0-000-000-0000 Fax: (000) 000-0000 Visit My Bupa in our display options: xxx.xxxxxxxxx.xxx/XxXxxx Outside the USA: Phone number can be located on your ID card, or at xxx.xxxxxxxxx.xxx YOUR HEALTHCARE PARTNER ONLINE TO MAKE YOUR LIFE EASIER! Log in to xxx.xxxxxxxxx.xxx, search for "My Bupa" in our display options and follow the registration steps with your email to manage your policy from the comfort of your home or office. Enjoy our online services: • Access to your policy documents and ID cards • Payments • Changes request • Claim request and update information • Pre-authorization services request • Costumer Service • Virtual Care (Telemedicine) You are responsible for checking all documents and correspondence online. BUPA GROUP PRESTIGE BENEFITS • Insurance for high risk disorders. • See applicable sections of the policy for details, limitations, and restrictions. • The plan Bupa Group Unless otherwise stated herein, insureds under this policy provides coverage in the Preferred Provider Network only. No benefits are payable for service rendered outside not required to obtain treatment from the Preferred Provider Network, except under the emergency medical treatment provision. • Maximum coverage is five two million dollars ($5,000,0002,000,000) per insured, per lifetime for all covered medical illnesses and hospital charges injuries while the policy is in force. • This policy only covers the disorders or medical necessities in the Schedule of Benefits, subject to the limitations herein, for any treatment, service and supply provided in Latin America, the Caribbean, and the United States of America. • The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured, per Policy Year) Maximum benefit Private or semi-private hospital room Neurological disorders, including cerebrovascular accidents $150,000 Cardiac surgery and board No limit Intensive care room angioplasty $150,000 Cancer treatment, including chemotherapy, radiotherapy and board No limit Maternity care benefit reconstructive surgery $200,000 Severe trauma (Except Plans IVmultiple trauma), V and VI) including rehabilitation $150,000 Chronic renal insufficiency (No deductible or coinsurance appliesdialysis) $2,500 Newborn coverage 100,000 Severe xxxxx, including reconstructive surgery $300,000 Major infectious disorder (No deductible or coinsurance appliesSepticemia) $25,000 Congenital and hereditary disorders: • Manifested before age 18 • Manifested on or after age 18 150,000 Organ transplants (per Insuredinsured, per lifetime) • Heart • Heart / Lung • Lung • Pancreas • Pancreas / Kidney • Kidney • Liver • Bone Marrow $100,000 300,000 $5,000,000 Organ transplant (per Insured, per lifetime) 300,000 $250,000 $250,000 $300,000 $200,000 $200,000 $250,000 Air ambulance transportation (per Insured, per lifetime) $25,000 Ground ambulance transportation (In Providers Network Not in Providers Network Regular room and board No limit $500 per incident) day Intensive care room and board No limit $1,000 Repatriation of mortal remains $5,000 Emergency treatment outside the Preferred Provider Network (per incident) $25,000 Disclosed pre-existing conditions (Lifetime maximum, per Insured after twenty-four (24) months of continuous coverage) $25,000 day DEDUCTIBLE • All insureds under the Certificate policy have a deductible responsibility per policy year according to the plan selected by the Certificate HolderPolicyholder. When applicable, the corresponding deductible amount is applied per insuredInsured, per policy year before benefits are paid or reimbursed to the insured. All deductible amounts paid accumulate towards the corre- sponding maximum deductible per policy, which is equivalent to the sum of two individual deductibles. All insureds under the policy contribute towards that insured’s deductible for the following policy year, as long as there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subse- quently the insured submits claims or requests for reimbursement for eligible expenses that occurred during the first nine (9) months of the policy year, the benefit will be reversed, and the insured will be responsible for the following policy year's deductible. to meeting the insuredmaximum deduct- COINSURANCE ible amount of the policy. All Once the maximum deductible amounts COINSURANCE paid accumulate towards amount of the corre- • The Insured is responsible for twenty sponding maximum policy is met, the insurer will consider all individual deductible per Certificate, which is equivalent to responsibili- ties as met. • Any eligible charges incurred by an insured during the sum of two individual deductibles. All insureds under the Certificate contribute to meeting the maximum last three (3) percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans IVExcept xxxx XX0, V and VIXX0, XX0, XX0). deductible amount months of the policy. Once policy year will apply • One (1) coinsurance liability per Insured, per the maximum deductible amount policy year. of the Certificate is met, the insurer • In the event of an accident involving will consider all individual deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for multiple members of an Insured family on the same certificateInsured, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. the following per policy year, as long as • If USA Medical Services is notified there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subsequently in accordance to the policy require- ments, then coinsurance will not apply to medical services in the country of residence (except Mexico). BUPA GROUP.

REQUIREMENT   TO   NOTIFY   THE   INSURER. The Insured must contact Bupa Insurance Company's ’s Claims Administrator, USA Medical Services, at least seventy-two (72) hours in advance of receiving any medical care. Emergency treatment must be notified within forty-eight (48) hours of commencement of such treatment. If the Insured fails to contact USA Medical Services as stated herein, the Insured will be responsible for thirty percent (30%) of all covered medical and hospital charges related to the claim, in addition to the plan's ’s deductible and coinsurance (if applicable). USA Medical Services can be contacted 24 hours a day, 365 days a year at the following telephone numbers: In the U.S.A.: (000) 000-0000 Free of charge from the U.S.A.: 0-000-000-0000 Fax: (000) 000-0000 Visit My Bupa in our display options: xxx.xxxxxxxxx.xxx/XxXxxx Outside the USA: Phone number can be located on your ID card, or at xxx.xxxxxxxxx.xxx YOUR HEALTHCARE PARTNER ONLINE TO MAKE YOUR LIFE EASIER! Log in to xxx.xxxxxxxxx.xxx, search for "My Bupa" in our display options and follow the registration steps with your email to manage your policy from the comfort of your home or office. Enjoy our online services: • Access to your policy documents and ID cards • Payments • Changes request • Claim request and update information • Pre-authorization services request • Costumer Service • Virtual Care (Telemedicine) You are responsible for checking all documents and correspondence online. BUPA GROUP PRESTIGE BENEFITS • Insurance for high risk disorders. • See applicable sections of the policy for details, limitations, and restrictions. • The plan Bupa Group Unless otherwise stated herein, insureds under this policy provides coverage in the Preferred Provider Network only. No benefits are payable for service rendered outside not required to obtain treatment from the Preferred Provider Network, except under the emergency medical treatment provision. • Maximum coverage is five two million dollars ($5,000,0002,000,000) per insured, per lifetime for all covered medical illnesses and hospital charges injuries while the policy is in force. • This policy only covers the disorders or medical necessities in the Schedule of Benefits, subject to the limitations herein, for any treatment, service and supply provided in Latin America, the Caribbean, and the United States of America. • The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured, per Policy Year) Maximum benefit Private or semi-private hospital room Neurological disorders, including cerebrovascular accidents $150,000 Cardiac surgery and board No limit Intensive care room angioplasty $150,000 Cancer treatment, including chemotherapy, radiotherapy and board No limit Maternity care benefit reconstructive surgery $200,000 Severe trauma (Except Plans IVmultiple trauma), V and VI) including rehabilitation $150,000 Chronic renal insufficiency (No deductible or coinsurance appliesdialysis) $2,500 Newborn coverage 100,000 Severe xxxxx, including reconstructive surgery $300,000 Major infectious disorder (No deductible or coinsurance appliesSepticemia) $25,000 Congenital and hereditary disorders: • Manifested before age 18 • Manifested on or after age 18 150,000 Organ transplants (per Insuredinsured, per lifetime) • Heart • Heart / Lung • Lung • Pancreas • Pancreas / Kidney • Kidney • Liver • Bone Marrow $100,000 300,000 $5,000,000 Organ transplant (per Insured, per lifetime) 300,000 $250,000 $250,000 $300,000 $200,000 $200,000 $250,000 Air ambulance transportation (per Insured, per lifetime) $25,000 Ground ambulance transportation (In Providers Network Not in Providers Network Regular room and board No limit $500 per incident) day Intensive care room and board No limit $1,000 Repatriation of mortal remains $5,000 Emergency treatment outside the Preferred Provider Network (per incident) $25,000 Disclosed pre-existing conditions (Lifetime maximum, per Insured after twenty-four (24) months of continuous coverage) $25,000 day DEDUCTIBLE • All insureds under the Certificate policy have a deductible responsibility per policy year according to the plan selected by the Certificate HolderPolicyholder. When applicable, the corresponding deductible amount is applied per insuredInsured, per policy year before benefits are paid or reimbursed to the insured. All deductible amounts paid accumulate towards the corre- sponding maximum deductible per policy, which is equivalent to the sum of two individual deductibles. All insureds under the policy contribute towards that insured’s deductible for the following policy year, as long as there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subse- quently the insured submits claims or requests for reimbursement for eligible expenses that occurred during the first nine (9) months of the policy year, the benefit will be reversed, and the insured will be responsible for the following policy year's deductible. to meeting the insuredmaximum deduct- COINSURANCE ible amount of the policy. All Once the maximum deductible amounts COINSURANCE paid accumulate towards amount of the corre- • The Insured is responsible for twenty sponding maximum policy is met, the insurer will consider all individual deductible per Certificate, which is equivalent to responsibili- ties as met. • Any eligible charges incurred by an insured during the sum of two individual deductibles. All insureds under the Certificate contribute to meeting the maximum last three (3) percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans IVExcept plan PL3, V and VIPL4, PL5, PL6). deductible amount months of the policy. Once policy year will apply • One (1) coinsurance liability per Insured, per the maximum deductible amount policy year. of the Certificate is met, the insurer • In the event of an accident involving will consider all individual deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for multiple members of an Insured family on the same certificateInsured, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. the following per policy year, as long as • If USA Medical Services is notified there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subsequently in accordance to the policy require- ments, then coinsurance will not apply to medical services in the country of residence (except Mexico). BUPA GROUP.

REQUIREMENT   TO   NOTIFY   THE   INSURER. The Insured must contact Bupa Insurance Company's ’s Claims Administrator, USA Medical Services, at least seventy-two (72) hours in advance of receiving any medical care. Emergency treatment must be notified within forty-eight (48) hours of commencement of such treatment. If the Insured fails to contact USA Medical Services as stated herein, the Insured will be responsible for thirty percent (30%) of all covered medical and hospital charges related to the claim, in addition to the plan's ’s deductible and coinsurance (if applicable). USA Medical Services can be contacted 24 hours a day, 365 days a year at the following telephone numbers: In the U.S.A.: (000) 000-0000 Free of charge from the U.S.A.: 0-000-000-0000 Fax: (000305) 000-000- 0000 Visit My Bupa in our display options: xxx.xxxxxxxxx.xxx/XxXxxx Outside the USA: Phone number can be located on your ID card, or at xxx.xxxxxxxxx.xxx YOUR HEALTHCARE PARTNER ONLINE TO MAKE YOUR LIFE EASIER! Log in to xxx.xxxxxxxxx.xxx, search for "My Bupa" in our display options and follow the registration steps with your email to manage your policy from the comfort of your home or office. Enjoy our online services: • Access to your policy documents and ID cards • Payments • Changes request • Claim request and update information • Pre-authorization services request • Costumer Service • Virtual Care (Telemedicine) You are responsible for checking all documents and correspondence online. BUPA GROUP CHOICE BENEFITS • See applicable sections of the policy for details, limitations, and restrictions. • The plan Bupa Group Choice policy provides coverage in the Preferred Choice Provider Network only. No benefits are payable for service services rendered outside the Preferred Choice Provider Network, except under the emergency medical treatment provision. • Maximum coverage is five one million dollars ($5,000,0001,000,000) per insuredInsured, per lifetime for all covered medical and hospital charges charges, while the policy is in force, subject to the limitations herein. • The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured, per Policy Year) Maximum benefit Private or semi-private hospital room and board No limit Intensive care room and board No limit Maternity care benefit (Except Plans IV, V and VI) (No deductible or coinsurance applies) $2,500 Newborn coverage (No deductible or coinsurance applies) $25,000 Congenital and hereditary disorders: • Manifested before age 18 • Manifested on or after age 18 (per Insured, per lifetime) $100,000 $5,000,000 Organ transplant (per Insured, per lifetime) $250,000 Air ambulance transportation (per Insured, per lifetime) $25,000 Ground ambulance transportation (per incident) $1,000 Repatriation of mortal remains $5,000 Emergency treatment outside the Preferred Choice Provider Network (per incident) $25,000 Disclosed pre-existing conditions (Lifetime maximum, per Insured after twenty-four (24) months of continuous coverage) $25,000 10,000 DEDUCTIBLE • All insureds under the Certificate policy have a an in-country and an out-of-country deductible responsibility per policy year according to the plan selected by the Certificate HolderPolicyholder. When applicable, the corresponding deductible amount is applied per insuredInsured, per policy year before benefits are paid or reimbursed following policy year, and subse- quently the insured submits claims or requests for requestsfor reimbursement for eligible expenses that occurred during the first nine (9) months of the policy year, the benefit will be reversed, and the insured will be responsible for the following policy year's deductible. before benefits are paid or reimbursed COINSURANCE to the insured. All deductible amounts COINSURANCE paid accumulate towards the corre- • The Insured is responsible for twenty paid accumulate towards the corre- sponding maximum deductible per Certificatepolicy, which is equivalent to the sum of two individual deductibles. All insureds under the Certificate policy contribute to meeting the maximum percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans IV, V deductible. to meeting the in-country and VI). deductible amount of the policy. Once out- • One (1) coinsurance per Insured, per the of-country maximum deductible amount policy year. of the Certificate is met, the insurer • In the event of an accident involving will consider all individual deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for multiple members of an Insured family on the same certificate, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. the following policy year, as long as • If USA Medical Services is notified there are no expenses incurred during the first nine (9) months amounts of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subsequently in accordance to the policy require- ments, then coinsurance will not apply to medical services in the country of residence (except Mexico). BUPA GROUP.

REQUIREMENT   TO   NOTIFY   THE   INSURER. The Insured must contact Bupa Insurance Company's ’s Claims Administrator, USA Medical Services, at least seventy-two (72) hours in advance of receiving any medical care. Emergency treatment must be notified within forty-eight (48) hours of commencement of such treatment. If the Insured fails to contact USA Medical Services as stated herein, the Insured will be responsible for thirty percent (30%) of all covered medical and hospital charges related to the claim, in addition to the plan's ’s deductible and coinsurance (if applicable). USA Medical Services can be contacted 24 hours a day, 365 days a year at the following telephone numbers: In the U.S.A.: (000) 000-0000 Free of charge from the U.S.A.: 0-000-000-0000 Fax: (000) 000-0000 Visit My Bupa in our display options: xxx.xxxxxxxxx.xxx/XxXxxx Outside the USA: Phone number can be located on your ID card, or at xxx.xxxxxxxxx.xxx YOUR HEALTHCARE PARTNER ONLINE TO MAKE YOUR LIFE EASIER! Log in to xxx.xxxxxxxxx.xxx, search for "My Bupa" in our display options and follow the registration steps with your email to manage your policy from the comfort of your home or office. Enjoy our online services: • Access to your policy documents and ID cards • Payments • Changes request • Claim request and update information • Pre-authorization services request • Costumer Service • Virtual Care (Telemedicine) You are responsible for checking all documents and correspondence online. BUPA GROUP SELECT BENEFITS • See applicable sections of the policy for details, limitations, and restrictions. • The plan Bupa Group Select policy provides coverage in the Preferred Provider Network only. No benefits are payable for service services rendered outside the Preferred Provider Network, except under the emergency medical treatment provision. • Maximum coverage is five two million dollars ($5,000,0002,000,000) per insured, per lifetime for all covered medical and hospital charges while the policy is in force, subject to the limitations herein. • The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured, per Policy Year) Maximum benefit Private Standard private or semi-private hospital room and board No limit Intensive care room and board No limit Maternity care benefit (Except Plans IV, V except plans Select 5 and VISelect 7) (No no deductible or coinsurance applies) $2,500 2,000 Newborn coverage (No no deductible or coinsurance applies) $25,000 10,000 Congenital and hereditary disordersHereditary Disorders: • Manifested before age 18 (per Insured, per lifetime) • Manifested on or after age 18 (per Insured, per lifetime) $100,000 $5,000,000 Organ transplant (per Insured, per lifetime) $250,000 2,000,000 Air ambulance transportation (per Insured, per lifetime) $25,000 50,000 Ground ambulance transportation (per incident) $1,000 Repatriation of mortal remains $5,000 Emergency treatment outside the Preferred Provider Network (per incident) $25,000 Disclosed pre-existing conditions (Lifetime maximum, per Insured after twenty-four (24) months of continuous coverage) $25,000 BENEFITS DEDUCTIBLE COINSURANCE • All insureds under the Certificate policy have a • The Insured is responsible for twenty an in-country and an out-of-country deductible responsibility per policy year according to the plan selected by the Certificate HolderPolicyholder. When applicable, the corresponding deductible amount percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans Select 5 and Select 7). is applied per insuredInsured, per policy year • One (1) coinsurance per Insured, per before benefits are paid or reimbursed policy year. to the insured. All deductible amounts • In the event of an accident involving paid accumulate towards the corre- sponding maximum deductible per policy, which is equivalent to the sum of two individual deductibles. All insureds under the policy contribute to meeting the in-country and out- of-country maximum amounts of the policy. Once the maximum deductible amounts of the policy are met, the multiple members of an insured family on the same policy, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. insurer will consider all individual • If USA Medical Services is notified in deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofbthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for the following policy year, as long as there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subse- quently the insured submits claims or requests for reimbursement for eligible expenses that occurred during the first nine (9) months of the policy year, the benefit will be reversed, and the insured will be responsible for the following policy year's deductible. to the insured. All deductible amounts COINSURANCE paid accumulate towards the corre- • The Insured is responsible for twenty sponding maximum deductible per Certificate, which is equivalent to the sum of two individual deductibles. All insureds under the Certificate contribute to meeting the maximum percent (20%) of approved charges for the first five thousand dollars ($5,000) after satisfaction of the applicable deductible (except plans IV, V and VI). deductible amount of the policy. Once • One (1) coinsurance per Insured, per the maximum deductible amount policy year. of the Certificate is met, the insurer • In the event of an accident involving will consider all individual deductible responsibilities as met. • Any eligible charges incurred by an insured during the last three (3) months ofthe policy year will apply to that policy year’s deductible and will also be carried over to be applied towards that insured’s deductible for multiple members of an Insured family on the same certificate, a maximum of two (2) coinsurances will be charged for this incident. Other coinsurance may be applicable for the members who were not charged coinsurance, for other illnesses or injuries not related to the accident. the following policy year, as long as • If USA Medical Services is notified there are no expenses incurred during the first nine (9) months of the policy year. If the benefit is granted to carry over the insured's deductible to the following policy year, and subsequently in accordance to with the policy require- ments, then coinsurance will not apply to medical services in the country of residence (except Mexico). BUPA GROUP.